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Biomedical subjects

N H Raskin

Publications and source records attributed to N H Raskin.

At least 19 recordsLinked to original sources
PubMed1990

Pharmacology of migraine.

Stabilization of serotonergic neurotransmission by depressing the activity of serotonergic neurons may be the common mode of action of drugs effective in migraine. By serotonin receptor agonism, by prolonging the biologic half-life of serotonin in the synaptic cleft (through blockade of its re-uptake or metabolic degradation), by an increase in its synthesis, by inhibiting the release of serotonin, or by activation of cyclic AMP (fig), a unitary expression for the action of these drugs can be formulated which is corroborated, for many of the drugs, by direct measurement of serotonergic neuronal firing rates. However, there are at least three serotonin receptor sites in brain at which drugs would be effective, as assessed by differential responsiveness to agonists and antagonists and by different types of postsynaptic responses: presynaptically, postsynaptically, and at the autoreceptor itself. The locus of action for the antimigraine drugs may be primarily at the raphe, upon the serotonin neurons per se, but it will probably prove to be more complex as more data are generated.

Brain↗
PubMed1990

Antimigraine treatment for slit ventricle syndrome.

Slit ventricle syndrome is characterized by chronic or recurring headaches associated with subnormal ventricular volume in patients who have undergone shunt treatment for hydrocephalus. There appear to be at least three pathophysiological mechanisms that cause this syndrome: 1) intermittent shunt malfunction; 2) intracranial hypotension; and 3) paroxysms of increased intracranial pressure in the presence of normal shunt function. To treat seven patients with slit ventricle syndrome caused by paroxysms of elevated intracranial pressure, we successfully used antimigraine therapy rather than standard calvarial expansion procedures. None of these patients has required shunt revision or calvarial expansion during a mean follow-up period of 2 years. The symptoms of slit ventricle syndrome may be a form of "acquired" migraine in shunt patients. We suggest that, in clinically stable patients with normal shunt function, treatment against migraine may stabilize symptoms resulting from paroxysms of increased intracranial pressure. Such treatment may prevent unnecessary shunt revisions and/or calvarial expansion procedures.

Adult↗
PubMed1990

Lumbar puncture headache: a review.

August Bier, the father of spinal anesthesia, suffered and reported the first lumbar puncture (LP) headache. On August 24, 1898 his assistant, a Dr. Hildebrandt, attempted to administer a spinal anesthetic to Dr. Bier; it was never completed because the syringe did not fit the already implanted spinal needle. Bier himself suggested that continued leakage of cerebrospinal fluid (CSF) through the dural puncture site was the cause of headache, a theory that has been embraced by the medical community; however, the mechanism is probably more complex. Nearly 50 years ago, J. Lawrence Pool, using an endoscopic technique to visualize the surface of the spinal cord and the cauda equina, frequently observed large collections of epidural fluid two to four days following lumbar puncture in patients without headache. Evidence that will be presented below suggests that CSF volume alterations may be the signal closest to the headache mechanism.

Age Factors↗
PubMed1990

Treatment of status migrainosus: the American experience.

Dependence upon a variety of drugs--ergotamine, analgesics, benzodiazepines, corticosteroids--is a major reason for patients to enter an intractable phase of their migrainous disorders. Repeated dosing of dihydroergotamine has proven to be remarkably effective in stabilizing the mechanism of migraine, allowing these patients to make the transition to a more reasonable as well as more specific form of therapy.

Acute Disease↗
PubMed1990

Modern pharmacotherapy of migraine.

Rectal ergotamine and naproxen are the major candidates for the ad hoc treatment of migraine attacks; for particularly dramatic episodes, intravenous DHE with prochlorperazine is the author's preference. For long-term stabilization, after simpler measures fail, valproate appears to be a major addition to migraine therapy.

Analgesics↗
PubMed1988

Relative utility of different electrophysiologic techniques in the evaluation of brachial plexopathies.

We report the results of detailed electrophysiologic studies in 23 patients with suspected brachial plexopathies. In five with neurogenic thoracic outlet syndrome, needle EMG and determination of size of ulnar sensory nerve action potentials (SNAPs) and thenar M waves were important in localizing the lesion; F-response and somatosensory evoked potential (SEP) studies were of more limited utility. All electrodiagnostic studies were normal in 10 patients with nonneurogenic thoracic outlet syndrome. In traumatic (three patients) or idiopathic brachial plexopathy (five patients), needle EMG was especially helpful but, in the former, SEP studies helped to guide management and, in the latter, to confirm the proximal site of the lesion when peripheral SNAPs were normal. The presence of preserved but small SNAPs but absent M waves in patients with traumatic plexopathies suggested a combined pre- and postganglionic lesion.

Action Potentials↗
PubMed1986

Thunderclap headache: symptom of unruptured cerebral aneurysm.

Many patients with a ruptured berry aneurysm report an intense sentinel headache of sudden onset in the weeks before rupture. Such headaches have been attributed to a leak of blood, which implies that partial rupture has occurred. A case is reported of a patient who had severe headaches which seemed to be caused by an unruptured cerebral aneurysm, accompanied by diffuse cerebral vasospasm. Headache episodes with the thunderclap profile may require angiography for diagnosis even if the cerebrospinal fluid is bloodless.

Adult↗
PubMed1986

Neuropsychologic alterations in classic and common migraine.

A neuropsychologic test battery was administered to 16 outpatients with classic migraine and 15 outpatients with common migraine between attacks and 15 matched nonheadache volunteers. Both migraine groups demonstrated significantly greater average neuropsychologic impairment and more self-reported cognitive difficulties than the nonheadache control group. Current medication use did not explain the relative neuropsychologic impairment. Both classic and common migrainous disorders seem to involve a disturbance of cerebral function beyond the attack itself.

Adult↗
PubMed1986

Repetitive intravenous dihydroergotamine as therapy for intractable migraine.

For patients with chronic intractable headache, we compared a new treatment and a traditional one. Fifty-five patients (36 dependent on ergotamine, analgesics, diazepam, or corticosteroids) were given IV dihydroergotamine (DHE) and metoclopramide every 8 hours. Fifty-four age- and sex-matched patients (38 drug-dependent) were given diazepam intravenously every 8 hours. Forty-nine of the 55 DHE-treated patients became headache-free within 48 hours, and 39 of them sustained benefits in a mean follow-up of 16 months. In contrast, 7 diazepam-treated patients became free of headache within 3 to 6 days, and 31 had improved somewhat in 10 days. Repetitive IV DHE helps to terminate cycles of intractable migraine.

Adult↗
PubMed1977

Carotidynia.

Nosologic uncertainty about carotidynia has arisen, in part, because the syndrome was initially classified as an atypical facial neuralgia. More recently, carotidynia has been characterized as a recurring vascular neck pain, often accompanied by carotid tenderness and soft tissue swelling and sometimes by vascular headaches. We now report that drugs useful in the prophylaxis of migraine appear to be effective in carotidynia. Eight women (ages 39 to 77) with unilateral, episodic neck pain of 1 to 19 years' duration have been observed for periods ranging from 7 months to 6 years. All experienced marked relief in the intensity and frequency of their pain syndromes after the administration of methysergide, ergonovine maleate, propranolol, or nortriptyline. No patient had evidence of arteritis. The responsiveness of both migraine headaches and carotidynia to similar drugs suggests a common pathophysiologic mechanism.

Adult↗